Aim: To assess the diagnostic usefulness of fecal leukocytes for diagnosis of inflammatory diarrhea in children attending a pediatric emergency hospital.Methods: We reviewed retrospectively the clinical records of children aged 0 through 18 years old who had attended the Hospital de Emergencias Pediátricas, Lima, Peru, from January through September 2002. All those cases in which fecal leukocytes and microbiological assessments had been requested were eligible. We categorized the counts of fecal leukocytes in the following categories:Results and discussion: Overall, 699 fecal samples were examined to quantitate fecal leukocytes; of these, 522 also underwent stool cultures. Cultures were positive in 223 patients (43%) and 299 resulted negative. A latex agglutination test for rotavirus was performed in 225 samples, and 87 were positive (38.6%). In general, the diagnostic usefulness of fecal leukocyte counts was low, except for the extremes of the spectrum (less than 5 leukocytes/hpf and more than 100 leukocytes/hpf). In the first case, sensitivity was 93%, LR+ was 1.3 and LR- was 0.25. This means that a positive result for the lowest counts has a very low probability of being due to an inflammatory enteropathogen; however, specificity was low (27%) and therefore a positive result cannot rule out the probability of an inflammatory diarrhea. When the count exceeded more than 100/hpf its sensitivity and specificity were rather low (62% and 72%, respectively), and the LR+ was 2.24, meaning that the probability of an inflammatory enteropathogen as the causative agent is doubled in cases with a positive result compared to those children with counts below 5 white blood cells per hpf.
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